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0245 GREAT MARSH ROAD - Health
145 GREAT MARSH ROAD r Centerville A = 210 — 136 - 002 i S M E A D No.24 53LOR UPC 12534 smead.com • Made In USA 3� y r Fl9tUSFDWTFtSPR00UCF1lE SFI OFUGSRPROMM souRcJtd(SD WWWWWROMAKORG Town of Barnstable P# � Department of Regulatory Services / 's Public Health Division Date Z�! 200 ain Street,HyartPiis MA 02 01 Date Scheduled / MR. 4 Fee Pd. So' Suit ility Assessment for Sew e os 8 , .x. / Performed By: � Witnessed By: LOCATION&GENERAL INFORMATION Location Address y� ��/� Owner's Name 2• ty y<C//1 i'1*24 .� �f Address <:feJ4 '7 JL Assessor's Map/Parcel:Z���36/OVA` Engineer's Namre, ft NEW CONSTRUCTION REPA62 Y Telephone# 608—,�6 -A/ Land Use Slopes(%) Surface Stones Distances from: Open Water Body ft Possible Wet 4ea ft Drinking Water Well ft Drainage Way ft Property Lift Other ft SKETCH:(Street name,dimensions of I exact locations of test oles& erc tests,locate wetlands in proximity to holes) L :e Parent material(geologic) Depth to Bedrock Depth to Groundwater: Standing Water in Hole: Weeping from Pit Face Estimated Seasonal High Groundwater DETERMINATION FOR SEASONAL HIGH WATER TABLE Method Used: Depth Observed standing in obs.hole: in. Depth to soil mottles: in. Depth to weeping from side of obs.hole: in. Groundwater Adjustment ft. Index Well# Reading Date: Index Well level Adj.factor Adj.Groundwater Level PERCOLATION TEST Date Time Observation Hole# Time at 9" Depth of Perc Time at 6" ✓�� Start Pre-soak Time @ Time(9"-6") End Pre-soak ,'Q Rate MinAnch E Site Suitability Assessment: Site Passed Site Failed: Additional Testing Needed(Y/N) Original: Public Health Division Observation Hole Data To Be Completed on Back----------- ***If percolation test is to be conducted within 100'of wetland,you must first notify the Barnstable Conservation Division at least one(1)week prior to beginning. Q:\SEPTIC\PERCFORM.DOC DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) �W N �Y v r DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Mansell) Mottling (Structure,Stones,Boulders. Consistency.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistencv.%Gravel) DEEP OBSERVATION HOLE LOG Hole# Depth from Soil Horizon Soil Texture Soil Color Soil Other Surface(in.) (USDA) (Munsell) Mottling (Structure,Stones,Boulders. Consistency,%Gravel) Flood Insurance Rate Map: Above 500 year flood boundary No Yes Within 500 year boundary No Yes Within 100 year flood boundary No Yes Death of Naturally Occurring Pervious Material Does at least four feet of naturally occurring pervt us ma rial exist in all areas observed throughout the area proposed for the sod absorption system? If not,what is the dep of aturally occurring pery us material?�� Certification I certify that on (date)I have passed the soil evaluator examination approved by the Department of Enviro ental Protection and that the above analysis was perfo ed y me co sistent with the required g,exp ti d e,perience described in 310 CMR 15.017. Signature Date �1 Q:\SEPCIC\PERCFORM.DOC No. Q0 IL � "' � Fee �� 00 THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: Yes PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS application for Misposal *pstem Construction Permit Application for a Permit to Construct( ) Repair( ) Upgrade( , Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Asse';s aplv /b � Installer's Name,Address,and el.No. Designer's Name,Address,and�N'40 Type of Building: Dwelling No.of Bedrooms Lot Size 013 qe__ sq.ft. Garbage Grinder( ) Other Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures Design Flow(min.requi ed) _ gpd Design flow provided gpd Plan Date 2 2 a 14,1 Number of sheets Revision Date Zv/ Title Size of Septic Tank 6411,&r-7W1] ype of S.A.S. 15—Jc Description of Soil ®� Nature of Repairs or Alterations(Answer when applicable) Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En iromn tal Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e h. Si ed Date Application Approved by Date Application Disapproved by Date for the following reasons Permit No. /y234,`y Date Issued y No., ILT �w� • Fee — ° THE COMMONWEALTH OF MASSACHUSETTS Entered in computer: PUBLIC HEALTH DIVISION - TOWN OF BARNSTABLE, MASSACHUSETTS Yes ftphtatlon for Bisposat.*pBt m,ConstrUttlon permit Application for a Permit to Construct( ) Repair( ) Upgrade( '-Abandon( ) ❑Complete System ❑Individual Components Location Address or Lot No. Owner's Name,Address,and Tel.No. Ass ssor s ap/Parce t�L Installer's Name,Address,and el.No. Designer's Name,Address,and Tel.Not 5���qwf ML- I Z401_0 � C� �-7 C,nm Type of Building: 2 • ot Size D�� Dwelling No.of Bedrooms ,�/ L �� sq.ft. Garbage Grinder( ) Other _ Type of Building No.of Persons Showers( ) Cafeteria( ) Other Fixtures " Design Flow(min:requi ed) gpd Design flow provided S gpd „ s Plan Date 7 'ji 2.O► Number of sheets Revision Date Title Size of Septic Tank � G. �fJ(/T ype of S.A.S. 13—6co G AL Description of Soil �` S p/( ( cn! n Nature of Repairs or Alterations(Answer when applicable) L50D ' Date last inspected: Agreement: The undersigned agrees to ensure the construction and maintenance of the afore described on-site sewage disposal system in accordance with the provisions of Title 5 of the En ironmental Code and not to place the system in operation until a Certificate of Compliance has been issued by this Board o e h. Si ed Date O Application Approved by �- Date V700 Application Disapproved by Date i for the following reasons - r Permit No. I-I)n JW Date Issued --------------------------------------------------------------------------------------------------------------------------------------- THE COMMONWEALTH OF MASSACHUSETTS BARNSTABLE,MASSACHUSETTS Certificate of Compliance THIS IS TO CERTLI,Y,,that the On-site Sewage Disposal system Constructed( ) Repaired( ) Upgraded Abandoned at Mi472� �k4V has been constructed in accordance T with the provisions of Title 5 and the for Disposal System Construction Permit No�L3l��"� (a+�3 dated 6ns Installer -W/A/qt- c1c.L-Ikz J� Designer (p)%_0 1-0 #bedrooms L Approved design fl w d The issuance of this permit shall not b cons k as a guarantee that the system will c'on as �!hDate ,�/4 Inspector / �t -` 0 ,UI ----------- - ------ - ------- - -- - = ------_------- No. �� " 6 Fee THE COMMONWEALTH OF MASSACHUSETTS PUBLIC HEALTH DIVISION-BARNSTABLE,MASSACHUSETTS Misposal *pstem ConstrUttn tt Permission is hereby granted to C i nstruct( ) Repair( ) Upgrade( n( ) System located at G /� C // and as described in the above Application for Disposal System Construction Permit. The applicant recognized his/her duty to comply with Title 5 and the following local provisions or special conditions. Provided:Construct' ust b completed within three years of the date of this pe it. Date ��/ Approved by Town of Barnstable Nw4�of1HE TQ Regulatory Services Richard V. Scali, Interim Director STA LE ASS. ' MASS. Public Health Division .� g i639' aTF1�ya' Thomas Mclean, Director 200 Main Street,Hyannis, TNLk 02601 Office: 508-862-4644 Fax: 508-790-6304 Installer & Designer Certification Form Date: Sewage Permits Z�o�o Assessor's �/Iap�l'arcel (� Desianer: �1t�1� � "� Installer: Address: �J�� � Address: C I)M_ MA On "6 was issued a permit to installea ( at ) �,,�,(installer) septic system at Lla , ►"1VQ�;4 �� � based on a design drawn by (address) � n Z �OIJ ►�C.�l� �. �li�� dated � 2 (designer) ZI certify that the septic system referenced above was installed substantially according to the design, which may include minor approved changes such as lateral relocation of the distribution box and/or septic tank. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the septic system referenced above was installed with major changes (i.e. greater than 10' lateral relocation of the SAS or any vertical relocation of any component of the septic system) but in accordance with State & Local Regulations. Plan revision or certified as-built by designer to follow. Strip out (if required) was inspected and the soils were found satisfactory. I certify that the system referenced above was constructed in com liance with the terms of the approval letters (if applicable) 0r DAVID B. MASON (In t 11 is Signature) -,w es ig ignature) (Affix Desib p Here) PLEASE RETURN TO BARNSTABLE PUBLIC HEALTH DIVISION. CERTIFICATE OF COMPLIANCE WILL NOT BE ISSUED UNTIL BOTH THIS FORTM A1�D AS- BUILT CARD ARE RECEIVED BY THE BARNI STABLE PUBLIC HEALTH DIVISION. THANK YOU. QASeptic\Designer Certification Form Rev 8-14-13.doc M1 08-06-20 14 a 1 e e =_ 1 LzA DEED RESTRICTION .W(e2 WHEREAS, Rodney and Virginia Roberts is the omaw of 245 Great Marsh Road, Centerville, MA, Property, duly recorded in Barnstable County Registry of Deeds in Plan Book 13267 , Page 255 ; WHEREAS, Rodney Roberts, Trustee and Virginia Roberts, Trustee, as the owner of said lot has agreed with the Town of Barnstable Board of Health to a restriction for three (3) bedrooms which can be included in any home built on said lot as a pre-condition to obtaining a disposal works construction permit in compliance with 310 CMR 15.000 State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage; WHEREAS, the Town of Barnstable Board of Health, as a pre-condition to granting a disposal works construction permit for a septic system in compliance with 310 CMR 15.200, State Environmental Code, Title V, Minimum Requirements for the Subsurface Disposal of Sanitary Sewage, and authorizing the issuance of a building permit for the construction of a single family home on this property, is requiring that the agreement for the restriction on the number of bedrooms in any house constructed on the lot be put on record with the Barnstable County Registry of Deeds by recording this document, NOW, THEREFORE, Rodney and Virginia Roberts, Trustee's does hereby place the following restriction on his above-referenced land in accordance with his agreement with the Town of Barnstable Board of Health, which restriction shall run with the land and be binding upon all successors in title: 1. 245 Great Marsh Road may exist as a house containing no more than three (3) bedrooms as exists as of this document date. Rodney and Virginia roberts, Trustee's agrees that this shall be permanent deed restriction affecting Parcel 136 located on Map 210 as 245 Great Marsh Road, Centerville, MA, and being shown on the plan recorded in Plan m1 Book 228 , Page 24 as Plan of Land by C. Frank Whiting, RLS dated 8/3/1987. Executed as a peaI d instrument day ofAU_�4 p2O O ner's signature J'C t2 / 4�12,o g s+ o Owner's signature �k COMMONWEALTH OF MASSACHUSETTS S 6 SS , 2014 Then a sonall appear d the ab9y-named, ;; ; , ki no mea the a son who execwl t �, �, 9 instrument and aa sa e o be before me N tary My'F:Cp Tres(dateOF ty���III...y.3®��iv yu BARNSTABLE REGISTRY OF DEEDS 1 i _ .._. Tj— ! �M s - - 414 T l _ (\ LAW We J 01---mom- mi majow No ME 0 mmommoom IS NOON 11011111111 M1 ONEEN mommommommommommom 0 so m MIEN MENNO I IN ONE 11101111111111 .......... .... ..... . NO NINE I No 11111111111101 MINN No I omr,.osimim 0 No ENO ommm No No 0 MINE 0 ■�� �■�� No ii HIMii ■�n��i� ll 1 0 NOR! No No MEN ON ml 1111111111111101 i�=�i� ii �iiiiNNi�i�� = 1101110111 � ii■� ONO 11 �1i MENi��iiii i�� iiiaiii / TOWN OF BARNSTABLE LOCATIONp�y7 ��G¢T QQ�� .. SEWAGE 9&1q- VILLAGe i ASSESSOR'S MAP&PARCEL INSTALLER'S NAME&PHONE N JAjZ SEPTIC TANK CAPACITY LEACHING FACILITY:(type) 44-- QQsize) )C /?5 -( i v , NO.OF BEDROOMS OWNER /i &X&S PERMIT DATE: COMPLIANCE DATE: Separation Distance Between the: { Maximum Adjusted Groundwater Table to the Bottom of Leaching Facility feet Private Water Supply Well and Leaching Facility(if any wells exist Ap on site or within 200 feet of leaching facility) 0 feet Edge of Wetland and L.aching Facility(if any Wetlands exist within 300 feet of leaching;facility). AM feet FURNISHED BY C4! N W 60 L4 we y o ' 9ttK ' 6V la'� THE Tp�� Town of Barnstable r Barnstable e Regulatory Services Department ;edeaC'i BARNSrAULE. ' "A . 04 �639, Public Health Division �� prE0 MAi p' 200 Main Street, Hyannis MA 02601 2007 Office: 508-862-4644 Richard V.Scali,Director FAX: 508-790-6304 Thomas A.McKean,CHO CERTIFIED MAIL# 7.012 1010 0000 2851 3634 June 12, 2014 Rodney & Virginia Roberts, TRS % Roberts Investment Trust 245 Great Marsh Road Centerville, MA 02632 ORDER TO COMPLY WITH STATE ENVIRONMENTAL CODE, TITLE 5 The septic system located at 245 Great Marsh Road, Centerville, MA was last inspected on 5/24/2014, by James D. Sears, a certified septic inspector for the State of Massachusetts. The inspection of the septic system showed that the system "Failed"under the guidelines of 1995 TITLE 5 (310 CMR 15.00) due to the following: • Distribution-box needs to be replaced -backup of sewage into facility system component. • Leaching pit is full, not leaching. Need to replace leaching- less than a V2 day's flow. You are ordered to repair or replace the septic system within sixty(60) days from the date you receive this notification. Failure to repair/replace the septic system within the deadline period will result in future enforcement action. PER ORDER OF TH BOARD OF HEALTH as cKean, R.S., CHO Agent of the Board of Health Q:\SEPTIC\Letters Septic Inspection Failures or Future Evl\245 Great Marsh Rd Cent Jun 2014.doc J Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Fo rm-Not for Voluntary Assessments 245 Great Marsh Road +. Property Address Juli Roberts Owner Owner's Name information Centerville MA 02632 5-24-14 required for every page. Cityrrown State Zip Code Date of inspection Inspection results must be submitted on this form. Inspection forms may not be altered in any way. Please see completeness checklist at the end of the form. Important:When filling out forms A. General Information `���pu►nurp���� on the computer, ������ ZN OF use only the tab s9o' 1. Inspector: key to move your ��� O= •• '•yG' cursor-do not James D.Sears z: JAMES e the return Name of Inspector �: :y key. z *: CapewideEnterprises,LLC ,By Company Name T RT1F -7:-1 13`1 153 Commercial Street p4���F 5 I N SP'i Company Address Mashpee MA 02649 City/Town State Zip Code 508-477-8877 S1623 Telephone Number License Number B. Certification I certify that I have personally inspected the sewage disposal system at this address and that the information reported below is true, accurate and complete as of the time of the inspection. The inspection was performed based on my training and experience in the proper function and maintenance of on site sewage disposal systems. I am a DEP approved system inspector pursuant to Section 15.340 of Title 5(310 CMR 15.000). The system: ❑ Passes ❑ Conditionally Passes ® Fails ❑ Needs Further Evaluation by the Local Approving Authority 5-24-14 spector's Signature Date The system inspector shall submit a copy of this inspection report to the Approving Authority(Board of Health or DEP)within 30 days of completing this inspection. If the system is a shared system or has a design flow of 10,000 gpd or greater, the inspector and the system owner shall submit the report to the appropriate regional office of the DEP. The original should be sent to the system owner and copies sent to the buyer, if applicable, and the approving authority. ****This report only describes conditions at the time of inspection and under the conditions of use at that time.This inspection does not address how the system will perform in the future under the same or different conditions of use. t5ins•3/13 Title 5 Offiaal Inspectio o Subsurface Sewage Disposal System-Page 1 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments r 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cost.) Inspection Summary: Check A,B,C,D or E/always complete all of Section D A) System Passes: ❑ I have not found any information which indicates that any of the failure criteria described in 310 CMR 15.303 or in 310 CMR 15.304 exist. Any failure criteria not evaluated are indicated below. Comments: Failed System B) System Conditionally Passes: ❑ One or more system components as described in the"Conditional Pass" section need to be replaced or repaired. The system, upon completion of the replacement or repair, as approved by the Board of Health, will pass. Check the box for"yes", "no"or"not determined" (Y, N, ND)for the following statements. If"not determined," please explain. The septic tank is metal and over 20 years old' or the septic tank(whether metal or not) is structurally unsound, exhibits substantial infiltration or exfiltration or tank failure is imminent. System will pass inspection if the existing tank is replaced with a complying septic tank as approved.by the Board of Health. "A metal septic tank will pass inspection if it is structurally sound, not leaking and if a Certificate of Compliance indicating that the tank is less than 20 years old is available. ❑. Y ❑ N ❑ ND(Explain below): t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 2 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) ❑ Pump Chamber pumps/alarms not operational. System will pass with Board of Health approval if pumps/alarms are repaired. B) System Conditionally Passes (cont.): ❑ Observation of sewage backup or break out or high static water level in the distribution box due to broken or obstructed pipe(s)or due to a broken, settled or uneven distribution box. System will pass inspection if(with approval of Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): ❑ distribution box is leveled or replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ The system required pumping more than 4 times a year due to broken or obstructed pipe(s). The system will pass inspection if(with approval of the Board of Health): ❑ broken pipe(s)are replaced ❑ Y ❑ N ❑ ND(Explain below): ❑ obstruction is removed ❑ Y ❑ N ❑ ND(Explain below): C) Further Evaluation is Required by the Board of Health: ❑ Conditions exist which require further evaluation by the Board of Health in order to determine if the system is failing to protect public health, safety or the environment. 1. System will pass unless Board of Health determines in accordance with 310 CMR 15.303(1)(b)that the system is not functioning in a manner which will protect public health, safety and the environment: ❑ Cesspool or privy is within 50 feet of a surface water ❑ Cesspool or privy is within 50 feet of a bordering vegetated wetland or a salt marsh t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 3 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments .�' 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection B. Certification (cont.) 2. System will fail unless the Board of Health (and Public Water Supplier, if any) determines that the system is functioning in a manner that protects the public health, safety and environment: ❑ The system has a septic tank and soil absorption system (SAS)and the SAS is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ The system has a septic tank and SAS and the SAS is within a Zone 1 of a public water supply. ❑ The system has a septic tank and SAS and the SAS is within 50 feet of a private water supply well. ❑ The system has a septic tank and SAS and the SAS is less than 100 feet but 50 feet or more from a private water supply well". Method used to determine distance: '*This system passes if the well water analysis, performed at a DEP certified laboratory, for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis must be attached to this form. 3. Other: D) System Failure Criteria Applicable to All Systems: You must indicate"Yes" or"No"to each of the following for all inspections: Yes No ® ❑ Backup of sewage into facility or system component due to overloaded or clogged SAS or cesspool ❑ ® Discharge or ponding of effluent to the surface of the ground or surface waters due to an overloaded or clogged SAS or cesspool El ® Static liquid level in the distribution box above outlet invert due to an overloaded or clogged SAS or cesspool ® ❑ Liquid depth in compolf is less than 6 below invert or available volume is less than Y2 day flow P/7-" t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 4 of 17 Commonwealth of Massachusetts . Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection B. Certification (cont.) Yes No ❑ ® Required pumping more than 4 times in the last year NOT due to clogged or obstructed pipe(s). Number of times pumped: ❑ ® Any portion of the SAS, cesspool or privy is below high ground water elevation. ❑ ® Any portion of cesspool or privy is within 100 feet of a surface water supply or tributary to a surface water supply. ❑ ® Any portion of a cesspool or privy is within a Zone 1 of a public well. ❑ ® Any portion of a cesspool or privy is within 50 feet of a private water supply well. ❑ ® Any portion of a cesspool or privy is less than 100 feet but greater than 50 feet from a private water supply well with no acceptable water quality analysis. [This system passes if the well water analysis, performed at a DEP certified laboratory,for fecal coliform bacteria indicates absent and the presence of ammonia nitrogen and nitrate nitrogen is equal to or less than 5 ppm, provided that no other failure criteria are triggered.A copy of the analysis and chain of custody must be attached to this form.] ❑ ® The system is a cesspool serving a facility with a design flow of 2000gpd- 10,000gpd. ® ❑ The system fails. I have determined that one or more of the above failure criteria exist as described in 310 CMR 15.303, therefore the system fails. The system owner should contact the Board of Health to determine what will be necessary to correct the failure. E) Large Systems: To be considered a large system the system must serve a facility with a design flow of 10,000 gpd to 15,000 gpd. For large systems, you must indicate either"yes"or"no"to each of the following, in addition to the questions in Section D. Yes No ❑ ❑ the system is within 400 feet of a surface drinking water supply ❑ ❑ the system is within 200 feet of a tributary to a surface drinking water supply ❑ El Area system is located in a nitrogen sensitive area (Interim Wellhead Protection Area—IWPA)or a mapped Zone II of a public water supply well If you have answered"yes"to any question in Section E the system is considered a significant threat, or answered"yes" in Section D above the large system has failed. The owner or operator of any large system considered a significant threat under Section E or failed under Section D shall upgrade the system in accordance with 310 CMR 15.304. The system owner should contact the appropriate regional office of the Department. t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 5 of 17 i Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection C. Checklist Check if the following have been done. You must indicate"yes"or"no"as to each of the following: Yes No ® ❑ Pumping information was provided by the owner, occupant, or Board of Health ❑ ® Were any of the system components pumped out in the previous two weeks? ® ❑ Has the system received normal flows in the previous two week period? ❑ ® Have large volumes of water been introduced to the system recently or as part of this inspection? ® ❑ Were as built plans of the system obtained and examined? (If they were not available note as N/A) ® ❑ Was the facility or dwelling inspected for signs of sewage back up? ® ❑ Was the site inspected for signs of break out? ® ❑ Were all system components, excluding the SAS, located on site? ® ❑ Were the septic tank manholes uncovered, opened, and the interior of the tank inspected for the condition of the baffles or tees, material of construction, dimensions, depth of liquid, depth of sludge and depth of scum? ❑ ® Was the facility owner(and occupants if different from owner)provided with information on the proper maintenance of subsurface sewage disposal systems? The size and location of the Soil Absorption'System (SAS)on the site has been determined based on: ® ❑ Existing information. For example, a plan at the Board of Health. ® ❑ Determined in the field(if any of the failure criteria related to Part C is at issue approximation of distance is unacceptable)[310 CMR 15.302(5)] D. System Information Residential Flow Conditions: Number of bedrooms(design): NA Number of bedrooms(actual): 4 DESIGN flow based on 310 CMR 15.203 (for example: 110 gpd x#of bedrooms): 440 I t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 6 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information Description: 1000 Gal.Tank D Box and pit. Number of current residents: 2 Does residence have a garbage grinder? ❑ Yes ® No Is laundry on a separate sewage system?(Include laundry system inspection ❑ Yes ® No information in this report.) Laundry system inspected? ❑ Yes ® No Seasonal use? ❑ Yes ® No Water meter readings, if available last 2 ears usage d 2012-46,000Gals g ( y g (gp ))' 2013-43,000Gal's Detail: Sump pump? ❑ Yes ® No Last date of occupancy: Present Date Commercial/Industrial Flow Conditions: Type of Establishment: Design flow(based on 310 CMR 15.203): Gallons per day(gpd) Basis of design flow(seats/persons/sq.ft., etc.): Grease trap present? ❑ Yes ❑ No Industrial waste holding tank present? ❑ Yes ❑ No Non-sanitary waste discharged to the Title 5 system? ❑ Yes ❑ No Water meter readings, if available: t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 7 of 17 Commonwealth of Massachusetts Title 5 Official inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M , 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Last date of occupancy/use: Date Other(describe below): General information Pumping Records: Source of information: 4-2011 /4-2014 Was system pumped as part of the inspection? ❑ Yes ® No If yes, volume pumped: gallons How was quantity pumped determined? Reason for pumping: Type of System: ® Septic tank, distribution box, soil absorption system ❑ Single cesspool ❑ Overflow cesspool ❑ Privy ❑ Shared system (yes or no) (if yes, attach previous inspection records, if any) ❑ Innovative/Alternative technology.Attach a copy of the current operation and maintenance contract(to be obtained from system owner)and a copy of latest ` inspection of the I/A system by system operator under contract ❑ Tight tank. Attach a copy of the DEP approval. ❑ Other(describe): r t5ins•3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 8 of 17 r Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form-Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. CityrFown State Zip Code Date of Inspection D. System Information (cont.) Approximate age of all components, date installed (if known)and source of information: 1986 Permit #86 - 1217. Were sewage odors detected when arriving at the site? ❑ Yes ® No Building Sew6r(locate on site plan): Depth below grade: 16"feet Material of construction: ❑ cast iron ®40 PVC ❑other(explain): Distance from private water supply well or suction line: feet Comments(on condition of joints, venting, evidence of leakage, etc.): Pipeing is 4" PVC SCH 40. Septic Tank(locate on site plan): 411 Depth below grade: feet Material of construction: ® concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑other(explain) If tank is metal, list age: years Is age confirmed by a Certificate of Compliance? (attach a copy of certificate) ❑ Yes ❑ No Dimensions: 1000 Gal. Precast Sludge depth: 1" t5ins•3113 Title 5 Official Inspection form:Subsurface Sewage Disposal System•Page 9 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Septic Tank(cont.) Distance from top of sludge to bottom of outlet tee or baffle 29" Scum thickness 0" Distance from top of scum to top of outlet tee or baffle 12" Distance from bottom of scum to bottom of outlet tee or baffle 18" How were dimensions determined? Asbuilt-TapeSludge Judge Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tank at working level. Tank at 4" below grade. In and outlet baffles. No sign of leakage. Grease Trap (locate on site plan): Depth below grade: feet Material of construction: ❑concrete ❑ metal ❑fiberglass ❑ polyethylene ❑other(explain): Dimensions: Scum thickness Distance from top of scum to top of outlet tee or baffle Distance from bottom of scum to bottom of outlet tee or baffle Date of last pumping: Date t5ins-3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 10 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. CitylTown State Zip Code Date of Inspection D. System Information (cont.) Comments(on pumping recommendations, inlet and outlet tee or baffle condition, structural integrity, liquid levels as related to outlet invert, evidence of leakage, etc.): Tight or Holding Tank(tank must be pumped at time of inspection)(locate on site plan): Depth below grade: Material of construction: ❑ concrete ❑ metal ❑ fiberglass ❑ polyethylene ❑ other(explain): Dimensions: Capacity: gallons Design Flow: gallons per day Alarm present: ❑ Yes '❑ No Alarm level: Alarm in working order: ❑ Yes ❑ No Date of last pumping: Date Comments(condition of alarm and float switches, etc.): *Attach copy of current pumping contract(required). Is copy attached? ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System•Page 11 of 17 Commonwealth of Massachusetts Title 5 Official Inspection form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Distribution Box(if present must be opened)(locate on site plan): Depth of liquid level above outlet invert 0 Comments(note if box is level and distribution to outlets equal, any evidence of solids carryover, any evidence of leakage into or out of box, etc.): D Box is 12"x16"-10" below grade w/one line out. Wall's are getting bad. Need to replace box. Pump Chamber(locate on site plan): Pumps in working order: ❑ Yes ❑ No* Alarms in working order: ❑ Yes ❑ No* Comments(note condition of pump chamber, condition of pumps and appurtenances, etc.): *If pumps or alarms are not in working order, system is a conditional pass. Soil Absorption System (SAS)(locate on site plan, excavation not required): If SAS,not located, explain why: .k t5ins•3/13 Tide 5 Official inspection form:Subsurface Sewage Disposal System•Page 12 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments M Sy0'� 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is Centerville MA 02632 5-24-14 required for every page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Type: ® leaching pits number: 1 ❑ leaching chambers number: ❑ leaching galleries number: ❑ leaching trenches number, length: ❑ leaching fields number, dimensions: ❑ overflow cesspool number: ❑ innovative/alternative system Type/name of technology: Comments(note condition of soil, signs of hydraulic failure, level of ponding, damp soil, condition of vegetation, etc.): Leaching is a precast pit. Pit and cover at 20" below grade. Pit is full, not leaching. Need to replace leaching. Cesspools (cesspool must be pumped as part of inspection)(locate on site plan): Number and configuration Depth—top of liquid to inlet invert Depth of solids layer Depth of scum layer Dimensions of cesspool Materials of construction Indication of groundwater inflow ❑ Yes ❑ No t5ins•3113 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 13 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments µM 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): Privy(locate on site plan): Materials of construction: Dimensions Depth of solids Comments(note condition of soil, signs of hydraulic failure, level of ponding, condition of vegetation, etc.): t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 14 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection D. System Information (cont.) Sketch Of Sewage Disposal System: Provide a view of the sewage disposal system, including ties to at least two permanent reference landmarks or benchmarks. Locate all wells within 100 feet. Locate where public water supply enters the building. Check one of the boxes below: ® hand-sketch in the area below ❑ drawing attached separately �E r -�-= -� - A R CAR 9-3= 3L 3 i i 3l r 4 39 t5ins-3113 Title 5 Official Inspection Fort:Subsurface Sewage Disposal System•Page 15 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. City/Town State Zip Code Date of Inspection D. System Information (cont.) Site Exam: ❑ Check Slope ❑ Surface water ❑ Check cellar ❑ Shallow wells Estimated depth to high ground water: 41'feet Please indicate all methods used to determine the high ground water elevation: ❑ Obtained from system design plans on record If checked, date of design plan reviewed: Date ❑ Observed site(abutting property/observation hole within 150 feet of SAS) ❑ Checked with local Board of Health -explain: ❑ Checked with local excavators, installers-(attach documentation) ® Accessed USGS database-explain: U.S.G.S. well SDW 252 at 46'w/5'ADJ. You must describe how you established the high ground water elevation: U.S.G.S. well SDW 252 at 46'w/5'ADJ. Bottom of pit at around 8' below grade. Before filing this Inspection Report, please see Report Completeness Checklist on next page. t5ins-3/13 Title 5 Official Inspection Form:Subsurface Sewage Disposal System-Page 16 of 17 Commonwealth of Massachusetts Title 5 Official Inspection Form _ Subsurface Sewage Disposal System Form -Not for Voluntary Assessments 245 Great Marsh Road Property Address Juli Roberts Owner Owner's Name information is required for every Centerville MA 02632 5-24-14 page. Cityrrown State Zip Code Date of Inspection E. Report Completeness Checklist ® Inspection Summary:A, B, C, D, or E checked ® Inspection Summary D(System Failure Criteria Applicable to All Systems)completed ® System Information—Estimated depth to high groundwater ® Sketch of Sewage Disposal System either drawn on page 15 or attached in separate file i t5ins-3/13 Title 5 Official Inspection Farm:Subsurface Sewage Disposal System-Page 17 of 17 THE COMMONWEALTH OF MASSACHUSETTS BOAR® OF HEALTH -..:OF......! .......: Appltra#tan for Btgpniia1 W,arkii Tnnstrnrttun Prrutit Application is hereby made for a Permit to Construct (Y) or Repair ( ) an Individual Sewage Disposal System at: .- .............................,( ...............................--.............. Location-Address or Lot No. . .. ----- W ..1� .Cf . II ^ L ddress �I Installer Address Type of Building Size Lot_Z5 _-___Sq. feet Dwelling—No. of Bedrooms......................................Expansion Attic ( ) Garbage Grinder f ) a Other—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Other fixtures Design Flow.............�.,5 ....................gallons per person per day. Total daily flow. .I�P.-_3-30_._..•.__.gallons. W Septic Tank—Liquid capacity,��?�gallons Length..�_�_ Width...�•�...J_--.. Diameter________________ Depth__S_�_. x Disposal Trench—No..................... Width.................... Total Length.................... Total leaching area•-_-•-----.._---_---sq. ft. Seepage Pit No...... Diameter-__--ZP._..... Depth below inlet..,,, ,4r7`... Total leaching area.25-7....sq. ft. Z Other Distribution box (L_� Dosing tank ( ) `-' Percolation Test Results Performed byA• ._t ! ! 1 ....................� Date.../P/�A� _.....__.. a Test Pit No. 1.. --____minutes per inch Depth of Test Pit----Z�.._____. Depth to ground water r-----__ fT4 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground water.. . -Ttd.®p���. Ri .. �.. -••-•.--••- •--•.....--••---•K-•••-•---••••-••-•-•-'-"••--......-•--••-•................••••.. O Description of Soil..........................................................0-36_.._�n. Sa$s�� � �� STEPHEN � U ......---•••-•-•--------........................................................��.-o•����... - = 1� �' • s, V,atSD1V' ern' xW --•----•---------------- --- ---------------•-----------•------------------------------------------------------------- o t^r - - ------------------------------------ -- d.�l�1d•-•ram --;o,p-:^-: :-?=�=&-® v, U Nature of Repairs or Alterations—Answer when applicable_________________ _________•-"_"___---_-________-••._-_..._-___-__ -•-•-•-••-------- .... ....--•---•--•-•---------•----•-----•---•"----------•--•.............•-----••---••----------------------•-•------•----.._......................•-------- Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System in ac rdance with the provisions of iIT?:;a. 5 of the State Sanitary Code— The undersigned further agrees not to place the system operatio t' a ert a of Compliance has been issued by the boar o health. Signedl`'` G - •�1.�1_.3.).R( / Date Application Approved By-•-••• -'-- ...-`!-- /3� - Date Application Disapproved for the f ollowing r asons:-----••------•---•-•••••-•-•-••...........................................................Da.e.............. ....-------•--...----------••--•-••••-•-•------ -•••---••................................................... ��77 Date Permit No.11_�_ ---1 ...7 - Issued....................................................... Date No...:............_...-- ( FEs.............................. THE COMMONWEALTH OF MASSACHUSETTS BOARD rr OF HEALTH ....OF......�J 1t.J % --"-- . ... ...... --.......................................... for Biopoottl Works To�notrurtion 1hrutit Application is hereby made for a Permit to Construct (y) or Repair ( ) an Individual Sewage Disposal System at: •-��-Z ....... - itJCat.._4�_--•-------------------------ImO10 "`..Z.-----•-----.....---------......------. Location-A dress or Lot No. am„..;u4lbgress'1�+� , �W Owner ( / Address ....................................................0.......................... --.----------•------•-----.-.------------•------------------------ Installer Address } d Type of Building Size Lot., .................Sq. feet aDwelling—No. of Bedrooms.___e�...................................Expansion Attic ( ) Garbage Grinder $;lo) aOther—Type of Building ............................ No. of persons............................ Showers ( ) — Cafeteria ( ) Otherfixtures -------------------------------------------------------------------_---------------•-•------------------ �-- .....gallons per person per day. Total daily flow W Design Flow............... g P P P Y• Y �.�(/lU--•---��,34�---------.gallons. W Ir Septic Tank—Liquid"capacity/ gallons Length. e..�4►' . Width../d.._ Diameter_____ _______ Depth..,., ... x Disposal Trench—No..................... Width_-...-.............. Total Length.................... Total leaching area....................sq. ft. 3 Seepage Pit No------/----------- Diameter....Pr.._.... Depth below inlet.. .,to?..... Total leaching area.2. ----- ft. Z Other Distribution box (11-f Dosing tank ( ) Percolation Test Results Performed bye-.,t�1���� ! � ...................... Date.._1� .�1- ------..-" Test Pit No. L.43 ___.minutes per inch Depth of Test Pit....13........ Depth to ground water _ 44 Test Pit No. 2................minutes per inch Depth of Test Pit.................... Depth to ground wa MA OF P4 ..... .. � ....................................---------• - �� - .... ff D Description of Soil..........-.............................................. -�3&-- ;'.ryaSd7! -. _ STEPHEN yG --- `'Y'' ji ?... 1 N -G• -- (7,.j�..... ... 4 AL"LYN ca UNature of Repairs or Alterations—Answer when applicable._-_______________________________________________________________ 'p,, ,�{s - I s Agreement: The undersigned agrees to install the aforedescribed Individual Sewage Disposal System i accordance with the provisions of T T:LEE, 5 of the State Sanitary Code—The undersigned further agrees not'-to place the system in operatio n 'I a_ ert• to' of Compliance has been issued by the board of health. fl f . 1 Signed----•------�---=•--•----------....................................................... ....--......--------...------•- Date - Application Approved By........ {i,17 �_ -�. _ n� ( - Date Application Disapproved for the following easons:••••-••-----••.....-•-••-•-•••-••••••---------••--•••-••------•••-•--------•••••----•......-••••------•......-- --------------•------------------•-•----......---------------------------......---------..........-..---------••••-•-••......-----•--•-•--•-•------•-••------••---••••------•-•••----••-•--•------------ Date Permit ...... ------- Issued........-.............................................. Date THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH ..........................................OF................................................................... ................ (Intif iratr of Tontp iatTrr THIS IS TO CERTIFY, That the Indi •dual Seizge Disposal System constructed ( ) or Repaired ( ) by -_ � t,- •--••• r:.-- ---�................................ Installer at................................................... -•-•••--._...-••----•--••--------•-••......--•---•- has been installed in accordance with the provisions of T�IE 5 of The State Sanitary Code as descril3 d in the application for Disposal Works Construction Permit ...........0 dated........ 1 3_'_ _.. .......... THE ISSUANCE OF THIS CERTIFICATE SHALL NOT BE C UE®AS A GUARA TEE THAT THE 4. SYSTEM WILL FUNCTION AT SFACTORY. 7,T7 � s3 �. ' DATE................................... -Y= Inspector---•---•----.....: �` -----•--•-------•- >• � THE COMMONWEALTH OF MASSACHUSETTS BOARD OF HEALTH OF � -- No1? 'f4-.--_------•---- FEE......(5:..fl..o. W011011a1 ork ion io �ernti# Permission is hereby gran ted.............. .. — ---------- -- c............... :•------- +............ .........._.... to Construct ( ) or Repair ( ) an Individual Sewage Dispos System at No...... ----- ►4 ( St - _ ��J Street as shown on the application for Disposal Works Construction d•�� � ermit N �.Z -2. D ated..�....-.-•----'•--1--2•-•--.-- ......... .......... ------ DATE.........N! s4...... _C7 Q Board of Health ,. }: FORM 1255 HOBS & WARREN,—INC., PUBLISHERS �t A .c- .i 0h(P/v0)-TOWN OF BARNS ABLE LOCATION W341 �2g,p SEWAGE # �',- VILLAGE � ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. 1�G"RouJ 7;00 SEPTIC TANK CAPACITY /0o0 G.Ac LEACHING FACILITY:(type) /(size) �Q r,� NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER -7aaA) BUILDER OR OWNER�.,.�641VIllr+rbw Coivs-rXtCn-N DATE PERMIT ISSUED: 1 DATE COMPLIANCE ISSUED: j I VARIANC`E/GRANTED: Yes No Aoo/ llJ j / 4 13 OP D B ' Cf-�l 0,r I j(,P/6U;--TOWN OF BARNS ABLE . LOCATION_ZG, �j��ar Ar-,q 9j SEWAGE # K— /P/ r VILLAGE ( -6 ituTroofc C ASSESSOR'S MAP & LOT INSTALLER'S NAME & PHONE NO. _R?G7zou�c�� yam$- ��70 SEPTIC TANK CAPACITY LEACHING FACILITY:(type) e6yc* p,,- (size) NO. OF BEDROOMS 3 PRIVATE WELL OR PUBLIC WATER -7cwA) BUILDER OR OWNER �— cEAry/��f►rxw �o T�ts%T7�N DATE PERMIT ISSUED: DATE COMPLIANCE ISSUED:: VARIANCE/GRANTED: Yes No �0,A G T5pq,^_& ace A D I - ------------- _ - - - - -- --- ------ --- - .- i i ASSESSORS MAP : ` �-c-�.v� z/ - TEST HOLE LOGS � PARCEL . Z �- l) 'the installation shall cou�i.:, witl►'1'itic V anJ 'town of 13oard of. tT FLOOD ZONE: v✓ health Ite ulations. �_-- '`� ��/ ' SOIL EVALUATOR : �I�ll� UL� g REFERENCE: W I TNES3 t,.� 1�Itb �I 2) 'flre installer shall verify the location of utilities, sewer inverts and septic - ----- -- components prior to installation and setting base elevations - � 7 DATE V ) �0) ( 1 !, /* 22g .� PERCOLATIO E:AT .-�Z 1� l�(, � , 3) All gravity septic piping to be 4 inch Sell 40 PVC at 1/8"per lioot. '(•he first ,_4_� � _ 2 - two feet out of the d-box to the leaching shall be level. 4) This plan is not to be utilized for property line determination nor any other -` TH- 1 T•N-2 purpose other than the proposed system installation. --._ 7= ,._. :11�� O O 5) All septic components must meet Title V speci ications. r� 1 IC 6) Parking sliall not be constructed over I I 10 septic components. 7) The property is bounded by property corners and property lines. 1 � f L�Q 8) The property owner shall review design considerations to approve of total LOCATION MAP / L�fl ' design flow slid number of bedrooms to be considered for design. Iteceipt of payment for the plait and installation based on the plan sliall be deemed ` ( approval of the design flow by the owner. Ci 9) The existing leaching or cesspools shall be pumped and filled with material i per'Title V abandonment procedures. 'those within the proposed SAS shall 7! be removed along with contaminated soil and replaced with clean sand per Title V specs. , 10 System components to be 10 feet from water line. Sewer lines crossing the - w9 ✓ water line shall be sleeved with 4 inch SCI140 PVC with ends grouted if -'�,., •—"'-��. ,�„o m��,,�,..., __ applicable. •The proposed SAS is being installed below the water service T��-'•' line. Thep line is to be sleeved as aforementioned and maintained ill lace. 11) If a garbage grinder exists it is to be removed and is the responsibility of the S E P I' I C SYSTEM DESIGN owner to ensure such. 12)The installer is to take caution in excavation around the gas line if such FLOW ESTIMATE i exists. 13)The installer shall verify the location, quantity and elevation of the sewer �l BEDROOM'S t.T 11C) GAL/DAY/BEDROOM - i GAL/DAY lines exiting the dwellingp 'rior to the installa(ion. d 14 This plan is representative only that a system can fit on a property meeting I r� ) p p p Y + V` SEPTIC TANK Title V requirements. GAL/DAY x 2 DA lS -4�6C)GAL \ USE 1 DDU GALLON SEPTIC TA K XX1!5T i W--fr) ki 2 o Y S01 1. ABSORPT i ON SYSfiEF� II)AV1 r N ll ! [ Zz +'_ SIDE AREA: >C t2�t✓3 '* ?C,�- , /� � i , UUN lA BOTTOM AREA s I Z," k D -7 d c os G I C SYSTEM SECT I ON �-F—PT `` - a � - r d -�-Tt�W1_ � �` ��' (�X( t � -I ( 3 ��` 4 ° i�AI �1�((. ___ 0 ( '' GAL .:� ►zcl EtZ. 5 ID i M�►� SEPT I C T NK �U p V lk�r� j� i ` �o� �7, 0 0 — ° Z a L 4* — 73 .2q _ .-�-- Tl K9- 2 c.. 7 ` SITE AND SEWA GE E PLAN LAN LOCATION : 6)2CA k >?0 �'p PREPARED FOR : j n0 SCALE DAV I D B . MASON, DATE: W � DBC ENVIRONMENTAL DESIGNS EAST SANDWICH . MA DATE I HEALTH AGENT ( 508 ) 833- 2177 P 'Zoe �f ) , r SOIL TEST PIT DATA: MICATES -� INDICATES SEPTIC TANK DETAIL: � `��-- DISTRIBUTION BOX DETAIL: LEACHING PIT DETAIL: REVISIONS PERC. OBSERVED NOT TO SCALE NOT TO SCALE TEST GROUNDWATER NOT TO SCALE ti(i i.)ATE NOTES- I. SEPTIC TANK SHALL BE STEEL 4 INLET AND OUTLET TEES TO BE CAST IRON OR � NO. OF OUTLETS: -� MANHOLE COVER LOAM 9 SEED TP +� I TP TP TP REINFORCED CONCRETE. SCNEQ 4O PVC, TEES TO BE CENTERED UNDER _ BROUGHT TO FINISH GRADE OR PAVEMENT _ GRD. EL. _a GRD. EL. _—_ GRD. EL. 2 SEPTIC TANK TO WITHSTAND H-10 LOADING MANHOLE COVER- NOTES! \ GRD. EL. --- r- --'-�---, �. � , . r . GW. EL. __�� GW. EL. --_-- GW. EL. - GW. EL. UNLESS UNDER PAVEMENT, DRIVES OR ! L DIST. BOX TO WITHSTAND H-10 LOADING 2"MIN.OF 1/8" r- TRAVELED WAYS,WHEREIN N-20 LOADINGI I UNLESS UNDER PAVEMENT, DRIVES OR TO 1/2" 12°MIN. FILL J !� �r✓,.�r , SHALL APPLY. i PRECAST 1 TRAVELED WAYS WHEREIN H-20 LOADING t WASHED -? i I I SHALL APPLY. STONE 3, ALL PIPE CONNECTIONS AND CONCRETE WANNOLF COVER " I DIST t ; a f j -' CONSTRUCTION TO BE WATERTIGHT, DROU"y TO F1rRSN aRAOE Box I 2. PROVIDE INLET TEE OR BAFFLE WHERE SLOPE Of T rm PVC INLET PIPE ❑ o � 11 o o Q ❑*' I r�-• I I INLET PIPE EXCEEDS 0.00 FT/FT, OR IN , mpw L--- J PUMPED SYSTEM. - _ I It'r�M r-�--- 0 0 0 0 o c� c❑ 0 0 COVER _ 3. FIRST TWO FEET OF PIPE OUT OF DIST =. �� NOTE GENERAL NOTES: j. .__ -- ----- -- ----- — 8 _,� LEACHING PIT TO f1 cT! Jt�l PLAN VIEW BOX TO BE LAID LEVEL. o Co� p o 0 0 o WITHSTAND H-10 LOADING �7 -- ° r UNLESS UNDER 1. THIS PLAN IS FOR DESIGN AND REMOVEAdLE- PF1=CAST o .; , u CONSTRUCTION OF THE SEWAGE NORMAL WATER LEVEL PAVEMENT,DRIVE OR `�'`' '► , T -�.-- COVER �\ �� 3/4"TO I I/2' o 0 o cr o ci o o ❑ TRAVELED WAY WHEREIN DISPOSAL FACILITY ONLY. Td Ufa•-�' , aA!'� r -� - - - - - - - - - - - -- - - - - - -- ��- ' DOUBLE LEACHING PIT c H-20 LOADING SHALL L_ 1 /4` _ �' ❑ ca o 0 o Q o o ❑ p. �� 2. ALL CONSTRUCTION METHODS AND � . WASHED APPLY. PROVIDE __ • 4 (no fIMs\ D E.O E. TITLE MATERIALS A5L AND NLOCAL FORM TBOARD INLET TEE pNO MASS. TS(I�yp� .I 1. �1� 4 STONE �. r � _ OF HEALTH REGULATIONS. [%.P.I�. TE-5'T f%J i — ►R[CA[T — 1 -- . '_ !� •1 W O O C7 p G7 O U f� O k ! •%0' YIN. OUTLET > !� r ![1tK 1. �' ! -1 !EE I t 1 Jo �� ! TANK LlpigD DE�TN TEE NOTE _ �•i i. Ataj .:y - '- '� � %l-- 4' INLET " �- -4 14 1 �� � o 0 o a c� I= o p ❑ 3 ALL PIPES LOCATED UNDER PAVEMENT 1ij Jt 4'OUTLET 1 e R TRA TRAVELED E 40W Y SHALLEQUAL - - - - - - - - - - - - - - •L_ _ _��• t rjr_I; - - - _ - ---------- L � �i ` Of A — 2 ----.�� ROTTOY ON LEVEL 6TASLE *A St J:*Do �,� wo �.d -BOTTOM ON -----_' - —' Pd• LEVEL STABLE �(� ! DIA ----- ------- — PLAN VIEW i� CROSS-SECTION VIEW CROSS-SECTION BASE / te ,� �� .�_�:-c SECTION 85,9 CROSS- DATE' DATE: DATE: DATE: /GS CONSTRUCTION NOTES: INVERT ELEVATIONS: TEST BY: TEST BY TEST BY: TEST BY: J ,.ram INVERT AT BUILDING _' WITNESSED 8Y: WITNESSED BY: WITNESSED BY: WITNESSED BY: �- - 1� Irafw __- _,-r- µ .j f„ /•. f- lG INVERT AT SEPTIC TANK(In) 7 - --- ` / .� '' �Y' . RPM INVERT AT SEPTIC TANK(Out) 14 32 PERC. RATE: PERC. RATE: PERC. RATE: PERC. RATE: MIN./INCH MIN./INCH = MIN./INCH MINJINCN V% INVERT AT DIST. BOX(in) 1 �- INVERT AT DIST. BOX(Out) `71 . 6c_ INVERT AT LEACHING PIT DATUM: BOTTOM OF LEACHING PIT_ r VERTICAL DATUM: A` ':z !�1 !;?Z-r A- " r..� i v~� f r U.S.G. S. MAXIMUM GROUND WATER ELEVATION - IN MARK USED: L'�/fti^.ti'` � /l. u ' . �'G?�E'r'�./�• �.' OBSERVED GROUNDWATER BE /� , T ` G V. �_ ELEVATION ----- y >•w O F r = �d TAG 80L'f '1 Y E EV - 5 RIA _ r, r �13P� DESIGN FLOW. 7 BEDROOMS AT i G.P.B./D Qz ...+�r _... . -.s 1� The BSC Group / 0� i ;� :4 L , 5E� REQUIRED SEPTIC TANK: Oe 4 ` OD , ''. --''' f GAL. SEPTIC TANK PROVIDED: -- �:..s�= ,f f GAL. 000 Cape Cod Surrey Consukants SIZE OF LEACHING FACILITY REQUIRED: ,/ .,�_�' DESIGN PERC. RATE .- , - Mw 11(�CH 3261 Main Street Route 6A Bamstable VillageNIA 02630 617 362 8133 SIZE OF LEACHNG FACLITY PROVIDED: PROJECT TITLE j0 -'� L �7 -- SEWAGE DISPOSAL SA _ SYSTEM DESIGN _ A'OTEs I LOCUS PLAN: I" = Z 083' (p it: � ( } /{ i l) F'fi OPElr T Y L lNES SNO{1'N 11EFEON {f'ERE COMP/LED FFi'OM A PLAN IIECG'/1'DED AT Tf1L-- f'Af'NSTA©LE COUNTY REG/STI?Y OF DFf_--US I - lN f'L AN aOOA' Z 2_ PAGE 29 AND DOE-S /VO7-'fr EPRESEIV T AN °off • ' LAKE ACTUAL SUF,'VEY ON THE GF,'OUND. - � , ESSIUNAL %rUF V SU/i'�EY'OR U�)IF Z PREPARED FOR 2) Tfi/S TOPCGRAPI//C SUfr VEY IV AS 11fADE ON THE GROUND Fr)' � �' � . Tfr�1DVS/T Aiti'D STADI.a �1!E1HOD. ,/ 1 �' ' y� '" `,, s► s c 'T /Lt. SW&L.DS,� "�.��1P� . �{ 3) l/�tiDERGF,'OUND UT/L/T/ES ltiEf?E COMP/l_E D F1_1'03/ A t-'A/L:ABC_E /1'E-COR1-)EU PLAINS OF UT/CITY CO11'1PAN1ES Ai1;V G'UGL IC AGENC%ES A lVD Afl'E AFF'FI'0,l'/11f11 TE ONLY 6Ef-ORE DES/G/V AND Cv/b�TRUCT/ON x , CALL ��D/1� SAFE „ / '800-3�'� - 4£i4•/ 1 `,. t {' —_ 4.Y, K ` ` ,FOCUS �5 _ DATE: lVe v. / Of /UNAL ,�Efr'-C/i/iL L)ATL P-0V7_E wF� COMP/DESIGN z-A STeEEr CHECK: , yr/ PLAN VIEW DRAWN --T A SCALE: t = 1 . FIELD hl' FILE NO --.-- - - DWG NO lc� r� �,, SHEET 0 21C, % FEET --- JOB NO. .k DZ ! OF � le}V�, ✓V